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The assessment of psychopathology among traumatized refugees: measurement invariance of the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25 across five linguistic groups.

ABSTRACT: Background: Questionnaires are widely used to assess the mental health status of refugees, whereas their construct validity largely remains unexplored. Objective: This study examined the construct validity of two widely-used instruments for the assessment of PTSD symptoms (Harvard Trauma Questionnaire [HTQ]; 16 items) and symptoms of anxiety and depression (Hopkins Symptom Check list-25 [HSCL-25]; 25 items) among Dutch and refugee patients with different linguistic backgrounds. Method: We applied exploratory factor analyses and measurement invariance analyses to test construct validity.Participants (n =1 256) were divided into five linguistic groups defined by language family, including four non-western linguistic groups (Indo-Iranian [n = 262], Niger-Congo [n = 134], Semitic [n = 288], and South Slavic languages [n = 199]) and one western linguistic group (Germanic languages; Dutch [n = 373]). Results: Exploratory factor analysis yielded a 3-factor structure of the HTQ and a 2-factor structure of the HSCL-25. Measurement invariance 20 analyses on the HTQ showed strong measurement invariance across the groups of refugee patients. However, Dutch patients reported milder symptom severity on most items of the HTQ. Measurement invariance analyses on the HSCL-25 (not conducted in Dutch patients) indicated partial strong measurement invariance across refugee patients. Conclusion: We conclude that mental health constructs measured by the HTQ and the HSCL25 25 are to a large extent interpreted in a similar way by refugee patients. This indicates that these instruments can be applied in non-western refugee patient populations, and that local idioms of distress and inherent response patterns may not play a major role when applying the HTQ and the HSCL-25 in these populations. Yet, whereas meaningful comparisons of observed PTSD and depression scores between groups of refugee patients with different non30 western linguistic background are feasible, comparisons between patients with a western and non-western linguistic background, as well as comparisons of anxiety scores, are likely to be biased. Future studies need to establish whether the commonly used cut-off scores of both questionnaires apply for refugee patients with non-western linguistic backgrounds.

SUBMITTER: Wind TR

PROVIDER: S-EPMC5632793 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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The assessment of psychopathology among traumatized refugees: measurement invariance of the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25 across five linguistic groups.

Wind Tim R TR van der Aa Niels N Knipscheer Jeroen J de la Rie Simone S

European journal of psychotraumatology 20170609 sup2

Background: Questionnaires are widely used to assess the mental health status of refugees, whereas their construct validity largely remains unexplored. Objective: This study examined the construct validity of two widely-used instruments for the assessment of PTSD symptoms (Harvard Trauma Questionnaire [HTQ]; 16 items) and symptoms of anxiety and depression (Hopkins Symptom Check list-25 [HSCL-25]; 25 items) among Dutch and refugee patients with different linguistic backgrounds. ...[more]

PMID: 29038686

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Project description:BackgroundIn populations at high risk of HIV infection, rates of depression can be elevated with far-reaching effects on overall well-being. There is limited research on depression among young women engaged in high-risk sexual behaviour in low and middle-income settings. We investigated the prevalence, correlates and factors associated with mean HSCL depression score among young women at high risk (aged 15-24 years old) in Kampala, Uganda.MethodsWe conducted a baseline analysis of a randomized controlled trial. Probable depression was measured using the 15-item Hopkins Symptoms Checklist for depression (HSCL). This checklist has been validated in Ugandan populations, and our reliability test gave a Cronbach alpha coefficient of 0.89. The test was administered to all the participants. Participants whose HSCL mean score was greater than 1.75 were categorized as having probable depression. Socio-demographics and behaviour data were collected and factors associated with mean HSCL depression score were analysed using multiple linear regression.ResultsData was available for 600 participants, mean age 20.4 (SD±2.44) years. The prevalence of probable depression was 56% (95% CI, 52%-60%). Probable depression symptoms were most prevalent among those who reported ever-experiencing violence from a sexual partner (64.7%), those aged between 20-24 years (58.2%) and those who reported more than 10 sexual exposures in the month prior to the interview (56.8%). At the adjusted analysis level, condom use during their last sexual intercourse prior to the survey decreased probable depression symptoms by 0.147 units compared to those who never used condoms (β = -0.147, 95% CI -0.266-0.027). Having experienced physical violence by a sexual partners increased mean HSCL depression score by 0.183 units compared to those who have never experienced violence (β = 0.183, 95% CI 0.068-0.300). Participants who reported ever using drugs of addiction had their mean HSCL depression scoreincrease by 0.20 units compared to those who have never used (β = 0.20,95% CI 0.083-0.317).ConclusionsProbable depression is high in this population and increased mean HSCL depression score is related to violence. Periodic screening for depression and interventions targeting depression, partner violence and risky sexual behaviours are recommended.

Project description:BackgroundThe Four-Dimensional Symptom Questionnaire (4DSQ) is a self-report questionnaire measuring distress, depression, anxiety and somatization with separate scales. The 4DSQ has extensively been validated in clinical samples, especially from primary care settings. Information about measurement properties and normative data in the general population was lacking. In a Dutch general population sample we examined the 4DSQ scales' structure, the scales' reliability and measurement invariance with respect to gender, age and education, the scales' score distributions across demographic categories, and normative data.Methods4DSQ data were collected in a representative Dutch Internet panel. Confirmatory factor analysis was used to examine the scales' structure. Reliability was examined by Cronbach's alpha, and coefficients omega-total and omega-hierarchical. Differential item functioning (DIF) analysis was used to evaluate measurement invariance across gender, age and education.ResultsThe total response rate was 82.4 % (n = 5273/6399). The depression scale proved to be unidimensional. The other scales were best represented as bifactor models consisting of a large general factor and one or more smaller specific factors. The general factors accounted for more than 95 % of the reliable variance of the scales. Reliability was high (≥0.85) by all estimates. The distress-, depression- and anxiety scales were invariant across gender, age and education. The somatization scale demonstrated some lack of measurement invariance as a result of decreased thresholds for some of the items in young people (16-24 years) and increased thresholds in elderly people (65+ years). The somatization scale was invariant regarding gender and education. The 4DSQ scores varied significantly across demographic categories, but the explained variance was small (<6 %). Normative data were generated for gender and age categories. Approximately 17 % of the participants scored above average on de distress scale, whereas 12 % scored above average on de somatization scale. Percentages of people scoring high enough on depression or anxiety as to suspect the presence of depressive or anxiety disorder were 4.1 and 2.5 respectively.ConclusionsEvidence supports reliability and measurement invariance of the 4DSQ in the general Dutch population. The normative data provided in this study can be used to compare a subject's 4DSQ scores with a general population reference group.

Dataset Information

The assessment of psychopathology among traumatized refugees: measurement invariance of the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25 across five linguistic groups.

Publications

The assessment of psychopathology among traumatized refugees: measurement invariance of the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25 across five linguistic groups.

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